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Date: August 8, 2013

Requirements of Contract Providers Regarding Prior Authorization Errors

Due to the continuance of Prior Authorization (PA) Errors, effective immediately, failure to respond to requests from the ADvantage Administration (AA) to resolve PA Errors will cause the provider agency to be removed from referral, for no less than three months.  In extreme cases of noncompliance, the contract provider could be referred to the Office of Inspector General’s Medicaid Fraud Unit.

The contract provider will only be sent two notifications regarding PA Errors, the initial notification, and then a second notification 2 weeks later, as a reminder.  If no response has been received from the provider, after 4 weeks from the original notification date, the contact person for the provider will be advised that the provider is being removed from referral for at least 3 months and until the PA error is addressed by the provider.

In cases where the PA Error is preventing service authorization on a Member’s service plan, the provider will be contacted by phone by an ADvantage Claims Resolution Specialist.  The provider agency is expected to act immediately to correct these errors, as they prevent an ADvantage Member from receiving services.

Beginning 09/01/13 all communication regarding PA errors will be sent to the provider agency via SMARTERMAIL.  ALL CONTRACT PROVIDERS are required to have a SMARTERMAIL account by this time.  If your agency is one of the few that still do not have a SMARTERMAIL account, please call the AAU at 918-933-4900 and ask for the Contracts Unit to set up an account. 

If you have any questions regarding the information provided above, please contact us at Provider Questions via your Smarter Mail account.

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